12 Things you need to know about back pain. Pain & Performance Clinic.

12 Things You Need To Know About Back Pain

Part 1

1. Scans are misleading and should come with a health warning

When people have scans for back pain, the scans often show up things that are poorly linked with pain. In fact, studies have shown that even people who don’t have back pain have things like bulging discs (52pc of people), degenerated or black discs (90pc), herniated discs (28pc) and ‘arthritic’ changes visible (38pc).

Remember, these people do NOT have pain! Unfortunately, people with back pain are often told that these things indicate their back is damaged, and this can lead to further fear, distress and avoidance of activity. The fact is that many of these things reported on scans are more like baldness – an indication of ageing and genetics that do not have to be painful.

2. Back pain is not caused by something being out of place

There is no evidence that back pain is caused by a bone or joint in the back being out of place, or your pelvis being out of alignment. For most people with back pain, scans do not show any evidence of discs, bones or joints being ‘out of place’.

In the very small number of people with some change in their spinal alignment, this does not appear to be strongly related to back pain.

Of course, it is worth noting that many people feel better after undergoing treatments like manipulation.

However, this improvement is due to short-term reductions in pain, muscle tone/tension and fear, NOT due to realigning of body structures.

For more on this please see what Paul Ingraham from PainScience.com has to say here

3. Bed rest is not helpful

In the first few days after the initial injury, avoiding aggravating activities may help to relieve pain, similar to pain in any other part of the body, such as a sprained ankle. However, there is very strong evidence that keeping active and returning to all usual activities gradually, including work and hobbies, is important in aiding recovery.

In contrast, prolonged bed rest is unhelpful, and is associated with higher levels of pain, greater disability, poorer recovery and longer absence from work. In fact, it appears that the longer a person stays in bed because of back pain, the worse the pain becomes.

4. More back pain does not mean more damage

This may seem strange, but we now know that more pain does not always mean more damage. Ultimately, two individuals with the same injury can feel different amounts of pain. The degree of pain felt can vary according to a number of factors, including the situation in which the pain occurs, previous pain experiences, your mood, fears, fitness, stress levels and coping style. For example, an athlete or soldier may not experience much pain after injury until later when they are in a less intense environment.

Furthermore, our nervous system has the ability to regulate how much pain a person feels at any given time. If a person has back pain it might be that their nervous system has become hypersensitive and is causing the person to experience pain, even though the initial strain or sprain has healed.

This can mean the person feels more pain when they move or try to do something, even though they are not damaging their spine.

Once people with back pain can distinguish between the ‘hurt’ they are feeling from any concerns about ‘harm’ being done to their back, it is easier to participate in treatment.

5. The perfect sitting posture does not exist 

Should we all sit up straight? Contrary to popular belief, no specific static sitting posture has been shown to prevent or reduce back pain. Different sitting postures suit different people, with some people reporting more pain from sitting straight, others from slouching. So while slouching gets a bad press, there is no scientific evidence to support this. In fact, many people with back pain can adopt very rigid postures (eg sitting extremely upright) with little variation.

The ability to vary our posture, instead of maintaining the same posture, together with learning to move in a confident, relaxed and variable manner is important for people with back pain.

For more on this please watch this Greg Lehman video here

6. Lifting and bending are safe 

Rest can help back pain settle initially but then you need to move. People with back pain often believe that activities such as lifting, bending and twisting are dangerous and should be avoided. However, contrary to common belief, the research to date has not supported a consistent association between any of these factors and back pain.

Of course, a person can strain their back if they lift something awkwardly or lifting something that is heavier than they would usually lift. Similarly, if a person has back pain, these activities might be more sore than usual. This, however, does not mean that the activity is dangerous or should be avoided.

While a lifting or bending incident could initially give a person back pain, bending and lifting is normal and should be practiced to help strengthen the back, similar to returning to running and sport after spraining an ankle.

Information provided by Dr Mary O’Keeffe (University of Limerick), Dr Derek Griffin (Tralee Physiotherapy Clinic), Dr Kieran O’Sullivan (Aspetar Orthopaedic and Sports Hospital, Doha, Qatar), Professor Peter O’Sullivan (Curtin University, Australia), Professor Chris Maher (The George Institute for Global Health, University of Sydney, Australia)

Please see Part 2 of this blog which goes through points 7-12


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